Persulfate hair bleach reactions. Cutaneous and respiratory manifestations

Ammonium persulfate is widely used to "boost" peroxide hair bleaches. These persulfates can produce a variety of cutaneous and respiratory responses, including allergic eczematous contact dermatitis, irritant dermatitis, localized edema, generalized urticaria, rhinitis, asthma, and syncope. Some of these reactions appear to be truly allergic while others appear to be due to the release of histamine on a nonallergic basis. Patch tests may be performed with 2% to 5% aqueous solution of ammonium persulfate. Scratch tests may result in asthma and syncope. In some patients, merely rubbing a saturated solution of ammonium persulfate into the skin will evoke a large urticarial wheal. Hairdressers should be made aware that these ammonium persulfate hair bleach preparations may provoke severe reactions and should seek medical attention if the client complains of severe itching, tingling, a burning sensation, hives, dizziness, or weakness.